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Jill Burcum -- Minneapolis Star Tribune
Wednesday, February 24, 1999
He's a world expert in flatulence. A specialist in the gas from your gut.
Despite the snickers this area of expertise often evokes, Dr. Michael Levitt of the Minneapolis Veterans Medical Center is proud to say that his life work has focused on that most unmentionable of body functions -- abdominal gas, or flatus as it's known scientifically.
"We do serious work here," Levitt says, gesturing to his colleagues and his laboratory.
Daring to go where few scientists have gone before, or have wanted to, Levitt has developed a unique niche in medicine as one of the world's only researchers of flatus. Figuring out what flatus is composed of, how it's made and, yes, even why it stinks has brought him world renown inside medicine and out. His scientific papers have been published and lauded in top journals. At the same time, he's a popular international lecturer with a slide show that includes a tabloid article showing an exploded toilet.
The silver-haired Levitt, who resembles the comic Sid Caesar, puts up with the inevitable jokes about his research subject. But he's quick to point out the seriousness of his work. Knowing more about the gas we pass, he says, may help doctors better understand and treat a variety of intestinal conditions.
"It's not considered a real high prestige area to work in," admits Levitt, who jokes that his lab at the VA Medical Center is the "explosion center of the United States." "But it's a good thing that somebody is doing it. We can't just ignore it because people don't want to talk about it."
Inevitably, the first question that visitors to Levitt's lab ask is: How did flatus become your life's work?
The answer begins back when Levitt, now 63, was a young resident-physician at Boston's elite Beth Israel Hospital, working under a prominent gastroenterologist, Franz Ingelfinger, who later became editor of the New England Journal of Medicine. Levitt was honored but terrified to work under the autocratic German.
At the end of Levitt's residency, the pragmatic Ingelfinger told him that his specialty should be abdominal gas because the field was wide open. "I would have a good chance of being successful," Levitt says with a laugh, "since no one else was studying it."
Levitt, a St. Paul native and University of Minnesota medical school graduate, didn't question his mentor. When he returned to the Twin Cities shortly thereafter to join the university staff, he began pursuing the field his mentor had chosen for him. He has been associate chief of staff at the VA hospital since 1978.
Levitt found that Ingelfinger was right. No one else was interested in it, other than a NASA scientist in California who was studying whether the flatus created by astronauts could explode.
Levitt liked the idea of filling a gap in scientific research. Thus began work that Levitt says literally and figuratively has been a gas.
Gut issues
A tour of Levitt's lab, where the test tubes contain feces and the blenders on the counters are definitely not used for mixing cocktails, starts off with some flatus facts.
First, everyone passes gas -- an average of 10 times a day.
Second, flatus really is a gas. Make that a combination of gases. Nitrogen, hydrogen, methane, carbon dioxide and sulfur compounds are the main ones. Nitrogen is the only flatus gas that's not made by your body. You take it in when you swallow air.
The remaining gases are byproducts of bacteria that live in your large intestine, Levitt says. Invading your body soon after birth, they multiply exponentially. "You have trillions of bacteria in your large intestine, more than the number of cells in your body," Levitt says.
There are no natural food sources in your large intestine, but the bacteria find it hospitable anyway. The reason is that their food is delivered to them daily -- courtesy of you. Every time you eat, bits of undigested food make their way to the large intestine, where ravenous bacteria lie in wait.
"When they get it, they go crazy," Levitt says.
Hydrogen, carbon dioxide, methane and sulfurous gases are produced by the bacteria's digestive processes. One of these -- hydrogen sulfide-- is primarily responsible for the flatus' telltale unpleasant odor.
"That's the culprit," Levitt confirms.
Practicing safe medicine.
It may not sound like a dramatic breakthrough for science, but Levitt's work truly does have serious medical applications.
Anyone who's had a sigmoid oscopy, a procedure in which a flexible tube is inserted into the rectum to check for colon cancer, can thank Levitt that there wasn't an explosion. Really.
Hydrogen, whether it's in the dirigible Hindenburg or your body, is flammable. That may be a source of delight to a teenager with a match but a dangerous problem when physicians want to burn off any abnormal growths found during a sigmoidoscopy. One spark can cause an explosion in the colon, Levitt says. There are documented cases of that happening.
Levitt was one of the researchers who helped solve the problem. He and his colleagues analyzed different liquids that patients would drink to clean the colon of feces and not contain any food for the bacteria.
They found that polyethylene glycol was the best agent. Patients around the world now regularly drink this thick preventative before undergoing the procedure.
Some of Levitt's most recent work may shed new light on ulcerative colitis and other intestinal conditions.
Ulcerative colitis is a chronic inflammation of the large intestine. It's a serious, uncomfortable and difficult-to-treat condition that affects about 320,000 Americans. Symptoms include bloody diarrhea, fever and abdominal pain, among others.
It's not clear what triggers the inflammation. But Levitt believes gas -- specifically hydrogen sulfide -- in the gut may play a role. Not only is it offensive to the nose, "it's even more poisonous than cyanide," Levitt says.
A study published by Levitt and colleagues in the January 1998 issue of the American Journal of Gastroenterology found that people with ulcerative colitis have elevated amounts of the gas in their feces and, therefore, in their flatus.
The study didn't draw any conclusions about why that occurs. But Levitt says that the findings support the theory that the toxic gas may irritate the sensitive lining of the large intestine, causing the condition. The unlucky person who contracts the disease could have more bacteria that produce the gas. Or, it could be that the lining of the large intestine is unusually sensitive.
Information about an intestinal condition with which parents of infants are well acquainted may lie in small blue-and-white bags piled in Levitt's lab.
The bags contain feces from infants receiving medical care at the University of Iowa. Levitt is working with researchers there to find the cause of colic, a mysterious condition that causes prolonged bouts of crying.
Again, Levitt suspects that gas in the large intestine may play a role. If colicky babies have high levels of hydrogen sulfide in their feces, it could be that the gas is irritating their intestinal linings before it's expelled.
Deflating myths
Levitt's work isn't always so scientifically strait-laced, however. He's often called on by private companies to test products for controlling gas and its odor. Beano, a product added to food to help prevent gas, was tested in Levitt's lab, but for proprietary reasons he can't reveal the results.
Another product, the Toot Trapper, a chair cushion designed to absorb flatus odor, scored well in tests. The research required some innovative equipment to prevent flatus from escaping so that researchers could measure the cushion's effectiveness. Fortunately, Levitt's wife Shirley came to the rescue. She designed and made a pair of pants from Mylar, the shiny airtight balloon material.
The cushion was placed inside the pants when volunteers put them on. Researchers then simulated flatus by infusing gas near the rectum while the volunteers sat on the cushion. By measuring the gas remaining in the pants, researchers could tell how much of the gas the product absorbed.
The Toot Trapper, Levitt reported, "was about 90 percent effective."
Levitt's work inevitably produces jokes, and his own sense of humor allows him to join right in. Thus he is a much-in-demand lecturer who delights audiences with his light touch.
For example, Levitt points out, although it is commonly believed that women don't pass gas as often as men, his studies show that that's not true. Despite what women tell him at cocktail parties, flatus occurs just as frequently in females, although they may not pass as much gas at one time. However, women's flatus on average contains more hydrogen sulfide. Translation: It smells worse.
Another myth is that the quieter the expulsion of flatus, the worse it smells; Levitt calls this the "silent-but-deadly theory." The critical factor isn't sound but, again, how much hydrogen sulfide the flatus contains.
Usually, audiences see the humor in the topic, Levitt says. But some groups just don't get it.
For example, "young women and the British will be roaring," he says. "But the Germans, they're hard to play to."
Looking back, Levitt says he's glad he took Dr. Ingelfinger's advice and claimed an area nobody else wanted. In the end, so to speak, he's had the last laugh. The subject has brought him a modicum of fame and enough money to put his kids through college, and has been the foundation of a satisfying career.
"I don't have any regrets," Levitt says.
Just don't ask him for any instant demonstrations.